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Laparoscopic Cholecystectomy that turned to open Cholecystectomy

  1. #1
    Question Laparoscopic Cholecystectomy that turned to open Cholecystectomy
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    I am from an Illinois ASC and we had a case recently that the Lap Chole had to be converted to open due to gallbladder inflammation. The open Cholecystectomy is not on the approved procedure list-we billed the open and have been appealing. My Physcian director thinks I should have billed the Lap Cholecystectomy as that was the intent and the procedure was 50% completed as Lap not open. I disagree I say we must bill what the procedure actually was. Does anyone have a good reference regarding coding of surgical procedures that have to converted during the surgical sessions.

  2. #2
    Location
    Cherry Hill, NJ
    Posts
    11
    Default Lap Chole converted to open procedure
    Hi. I would bill the lap chole as originally scheduled but also with the dx code "lap procedure converted to open". I would also use modifier, I believe 58, as it is a related procedure and mail a copy of the operative report with the claim. Hopefully this will help. Good lock.
    emma flattery
    Emma Flattery, CPC,CGSC

    [email]njcoder@outlook.com

  3. #3
    Default
    Hello,

    The response from eflatterycpc is incorrect. You must bill the open procedure with the diagnoses code of laparascopic converted to open. Once a procedure is converted to open you can not bill for the laparascopic portion.

  4. #4
    Location
    Cherry Hill, NJ
    Posts
    11
    Default
    I disagree. If the doctor attempts a procedure but is stopped , he still performed a service which is y I said use a modifier. Then bill the open with the convert to open code. I just read a similar situation in the Medicare coding magazine. Send your op note with the claim.
    Thans
    eflatterycpc
    Emma Flattery, CPC,CGSC

    [email]njcoder@outlook.com

  5. Default You should not bill the lap chole
    You bill the open chole with the original diagnosis for doing the surgery, the diagnosis of inflamed gallbladder, and the lap converted to open code V64.41.
    This is the way I have always done it and when I took the exam for my General Surgery specialty credential, this was mentioned in the AAPC study guide for the exam.

  6. #6
    Default
    I agree with gscoder. I worked in General Surgery for 5 1/2 years. Billing the open chole has always been the appropriate way to bill in this situation.

  7. #7
    Location
    Charleston, WV
    Posts
    245
    Default
    Quote Originally Posted by eflatterycpc View Post
    I disagree. If the doctor attempts a procedure but is stopped , he still performed a service which is y I said use a modifier. Then bill the open with the convert to open code. I just read a similar situation in the Medicare coding magazine. Send your op note with the claim.
    Thans
    eflatterycpc
    You only billl the attempted procedure if it was discontinued and no further procedure was done. (Bill with modifier -53). If a laparoscopic procedure is converted to open you must bill the open procedure only and add dx V64.41.

  8. #8
    Default
    I know this is late but you code only for the open procedure, and use dx. V64.41. Here is an article with more info: http://www.fortherecordmag.com/archi...12006p34.shtml

  9. #9
    Default A little late but the correct billing
    nc_coder is correct. You bill for what was performed, the open chole code with the original dx code, you have to identify medical necessity and then the convert to open code as your secondary dx code. You would never bill for both procedures, that is incorrect coding. Modifier -53 is only used if the procedure was not performed and no other procedure was performed.

  10. #10
    Default code the open proc
    When you have a lap procedure and converts to open. Code the open px.

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